The 5-Year Outcome of the Ponseti Method in Children With Idiopathic Clubfoot and Arthrogryposis
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Background: The Ponseti method effectively treats idiopathic clubfoot, but its effectiveness in treating the stiffer clubfoot associated with arthrogryposis is less clear. The purpose of this study was to assess the comparative effectiveness of the Ponseti method in 5-year-old children with either idiopathic clubfoot or clubfoot due to arthrogryposis. Methods: The outcomes of the Ponseti method were retrospectively evaluated in children with idiopathic clubfoot and clubfoot associated with arthrogryposis. The children with clubfoot were seen at our hospital between 2012 and 2019 and were 4.0 to 6.9 years old at the time of their evaluation. Outcomes of the 2 groups of children with clubfoot were assessed using passive range of motion, foot pressure analysis, the Gross Motor Function Measure Dimension-D, and parent report using the Pediatric Outcomes Data Collection Instrument. These results were also compared with the same measures from a group of typically developing children. Surgical and bracing history was also recorded. Results: A total of 117 children were included (89 idiopathic clubfoot and 28 associated with arthrogryposis) with an average age of 4.8±0.8 years. The historical gait analyses of 72 typically developing children were used as a control, with an average age of 5.2±0.8 years. Significant residual equinovarus was seen in both children with idiopathic clubfoot and associated with arthrogryposis according to passive range of motion and foot pressure analysis when compared with normative data. Children with arthrogryposis demonstrated limited transfer and basic mobility, sports functioning, and global functioning while children with idiopathic clubfoot were significantly different from their typically developing peers in only transfer and basic mobility. Conclusions: Although children with idiopathic clubfoot continue with some level of residual deformity, the Ponseti method is effective in creating a pain-free, highly functional foot. In children with clubfoot associated with arthrogryposis, the Ponseti method is successful in creating a braceable foot that can delay the need for invasive surgical intervention. Level of Evidence: Level III, Therapeutic Studies—Investigating the Results of Treatment.Keywords:
Ponseti Method
Arthrogryposis multiplex congenita
Congenital talipes equinovarus
Clubfoot associated with arthrogryposis has been traditionally considered very resistant to manipulation and casting, and therefore has required surgical correction. The purpose of this study was to evaluate the results of the Ponseti method of clubfoot casting in this patient population. We reviewed the records of patients with clubfoot associated with arthrogryposis consecutively treated at our respective institutions from January 1992 to December 2004. All patients were treated by serial manipulations and casting following the principles of the Ponseti method. Main outcome measures included initial correction of the deformity, relapses and the need for surgical releases or any other surgeries. Average age at last follow up was 4.6 years. There were 16 patients, all with bilateral deformities (32 clubfeet). there were 11 males and 5 females. Nine patients had both upper and lower extremity involvement. Seven patients had previous treatment elsewhere and one patient had an Achilles tenotomy. Initial correction was obtained in all but 1 patient. Average number of casts required for correction was 7 (range: 5 to 12). Average post-tenotomy dorsiflexion was 5 degrees. One patient required a posterior-medial release (PMR) for insufficient initial correction. Four cases required subsequent surgery for relapses (1 bilateral PMR with a repeat left PMR; 2 posterior releases (PR), 1 PR and anterior tibialis transfer (ATT), and 1 ATT). No talectomies were required. This study demonstrates that the Ponseti method is very effective for the correction of patients with clubfoot associated to arthrogryposis. Although this deformity is more rigid than in idiopathic clubfoot, many cases can be corrected when started in the first few weeks after birth.
Ponseti Method
Tenotomy
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Congenital Talipes Equinovarus is the most common congenital condition rst described by Hippocrates. The term ―”Talipus Equinovarus” is derived from the Latin: Talus means ankle; pes means foot and equinus meaning ―”horselike” (plantarexed) and varus meaning inversion plus adduction.1 Congenital talipes equinovarus (CTEV), commonly known as congenital 2 clubfoot, is one of the most prevalent birth disorders affecting the musculoskeletal system and is found in one out of every 1,000 live births. Every year, a large number of infants are born with congenital clubfoot. One CTEV occurs for every 1000 live births. The majority of these children were born in nations where they continue to receive inadequate or no treatment, which lowers their quality of life. The controversy around CTEV has existed and been known to mankind since the beginning of existence. These topics have been the focus of several studies, all of which have helped us comprehend the pathoanatomy and choose the best course of action. However, according to the literature, treatment for clubfoot is often successful in all cases. We documented the functional results of the Ponseti method's serial cast repair of CTEV in our study.
Congenital talipes equinovarus
Ponseti Method
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Introduction: Clubfoot, one of the most common congenital deformities of foot, requires early initiation of intensive treatment. Early initiation of treatment seems to result in better outcomes as observed by many orthopaedic surgeons. This study aims to assess the efficacy of Ponseti technique in correcting idiopathic congenital talipes equinovarus deformity of foot. Materials and methods: It is a prospective study of 248 cases with 318 feet attending CTEV clinic in a tertiary care hospital from September 2011 to August 2018 all of whom were diagnosed to have idiopathic clubfoot. Patients with syndromic clubfoot, with neuromuscular diseases and those presenting after previous failed treatment were not included in this study. Pirani scoring system was used to assess the severity of clubfoot deformity and weekly scoring was made to assess the improvement during the course of treatment. All patients were treated by serial casting with Ponseti method. Achilles tenotomy was needed in 212 patients (85.4%). Results: In this study, good results were achieved in 96.7% of patients while 3.22% had fair results with Ponseti technique of treating congenital talipes equino varus. No poor results were seen in this study indicating failure of treatment using Ponseti technique. Conclusion: Ponseti method of manipulation followed by serial casting proves to be an effective way of managing idiopathic clubfoot provided the techniques and principles are adhered to and treatment started at the earliest.
Ponseti Method
Congenital talipes equinovarus
Tenotomy
Foot (prosody)
Tertiary care
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Background: The Ponseti method effectively treats idiopathic clubfoot, but its effectiveness in treating the stiffer clubfoot associated with arthrogryposis is less clear. The purpose of this study was to assess the comparative effectiveness of the Ponseti method in 5-year-old children with either idiopathic clubfoot or clubfoot due to arthrogryposis. Methods: The outcomes of the Ponseti method were retrospectively evaluated in children with idiopathic clubfoot and clubfoot associated with arthrogryposis. The children with clubfoot were seen at our hospital between 2012 and 2019 and were 4.0 to 6.9 years old at the time of their evaluation. Outcomes of the 2 groups of children with clubfoot were assessed using passive range of motion, foot pressure analysis, the Gross Motor Function Measure Dimension-D, and parent report using the Pediatric Outcomes Data Collection Instrument. These results were also compared with the same measures from a group of typically developing children. Surgical and bracing history was also recorded. Results: A total of 117 children were included (89 idiopathic clubfoot and 28 associated with arthrogryposis) with an average age of 4.8±0.8 years. The historical gait analyses of 72 typically developing children were used as a control, with an average age of 5.2±0.8 years. Significant residual equinovarus was seen in both children with idiopathic clubfoot and associated with arthrogryposis according to passive range of motion and foot pressure analysis when compared with normative data. Children with arthrogryposis demonstrated limited transfer and basic mobility, sports functioning, and global functioning while children with idiopathic clubfoot were significantly different from their typically developing peers in only transfer and basic mobility. Conclusions: Although children with idiopathic clubfoot continue with some level of residual deformity, the Ponseti method is effective in creating a pain-free, highly functional foot. In children with clubfoot associated with arthrogryposis, the Ponseti method is successful in creating a braceable foot that can delay the need for invasive surgical intervention. Level of Evidence: Level III, Therapeutic Studies—Investigating the Results of Treatment.
Ponseti Method
Arthrogryposis multiplex congenita
Congenital talipes equinovarus
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Background. Clubfoot is the most common deformity in arthrogryposis and is characterized by a high degree of rigidity and a tendency to relapse. At present, no consensus exists on the issue of treatment of this pathology. The aim of this study was to demonstrate the possibilities of Ponseti method for the treatment of clubfoot in the younger children with arthrogryposis. Material and methods. The study was based on an analysis of treatment outcomes in 64 children (124 feet) under 3 years. 50 patients (78%) had a congenital multiple arthrogryposis, 14 children (22%) had a distal form of the disease. All the children underwent conservative treatment using Ponseti method. Results. After phased plastering by Ponseti method, the children with congenital multiple arthrogryposis aged under 1 year demonstrated correction of deformity components in 25 (48%) feet and the children from 1 to 3 years in 4 (8.7%) feet. Phased plastering in the children under 1 year with the distal form of the disease resulted in the correction in all 7 (100%) feet. In the patients with a similar form of the disease aged from 1 to 3 years, correction was achieved in 3 (23%) feet. In the cases of incomplete correction of deformity elements, when the possibilities of phased plastering were exhausted, different surgical interventions were performed. However, in neither case the surgery to remove talus was required. Conclusion. Ponseti method is most effective for the treatment of clubfoot in the children of the first year. Application of this method allows for elimination of clubfoot or significant reduction of the volume of subsequent surgery.
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Conservative Treatment
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Talipes equinovarus or clubfoot is a congenital deformity of the foot with bone, muscle, and tendon involvement. It is one of the most frequent foot malformations in pediatric orthopedics. Although generally idiopathic, it may have a syndromic cause and be associated with musculoskeletal, neurological, or connective tissue conditions. The treatment of choice in idiopathic clubfoot is the Ponseti method based on manipulation and fixation with serial casts that seek progressive correction of the deformity. The Ponseti method effectiveness has been demonstrated in arthrogryposis and myelomeningocele clubfoot. There are few clinical studies demonstrating the efficacy of this therapeutic option in patients with syndromic clubfoot. Retrospective study with 6 patients (9 feet) with syndromic clubfoot treated in a tertiary center with the Ponseti method with a minimum follow up of two years (2–18). The results were evaluated with the Pirani classification, assessing clubfoot severity before and after treatment. Of the six patients treated were used an average of 6.5 casts. The Pirani scale obtained a mean score of 5.2 before treatment, with a decrease to 1.27 after treatment, with a mean improvement of 3.93 points. In more than half of the cases it was necessary to lengthen the Achilles tendon to correct the equine deformity. In addition, an ankle-foot orthosis was used to reduce recurrences in patients with dysmetria or psychomotor retardation. The most frequently observed residual deformity was the adduct. A patient relapsed twice. The Ponseti method obtains effective results in the correction of syndromic clubfoot, although it requires a greater number of corrective casts than other pediatric foot pathologies. El pie zambo supone una de las malformaciones congénitas del pie más frecuentes. Generalmente la etiología es idiopática. Sin embargo, pueden presentar una causa sindrómica y asociarse con afecciones musculoesqueléticas, neurológicas o del tejido conjuntivo, recibiendo en estos casos, la denominación de pie zambo sindrómico. El tratamiento de elección del pie zambo idiopático es el método Ponseti, basado en la manipulación y yesos seriados. También se ha demostrado su utilidad en pie zambo asociado con artrogriposis y mielomeningocele, pero existen pocas publicaciones sobre la eficacia en el pie zambo sindrómico. Estudio retrospectivo en seis pacientes (nueve pies) con pie zambo sindrómico tratados en un centro terciario siguiendo el método Ponseti. Tiempo de seguimiento mínimo de dos años (2-18). Los resultados fueron evaluados con la clasificación de Pirani, para valorar la severidad del pie zambo, previa y posteriormente al tratamiento. En los seis pacientes tratados, se emplearon una media de 6,5 yesos. La escala de Pirani obtuvo una valoración media de 5,2, previamente al tratamiento, con un descenso hasta 1,27 tras el tratamiento, con una mejoría media de 3,93 puntos. En más de la mitad de los casos fue necesario una tenotomía del tendón Aquileo para corregir la deformidad en equino. Se utilizó una ortesis tobillo-pie para reducir las recidivas si retraso psicomotor o dismetría severa. La deformidad residual más frecuente fue el aducto, que no requirió tratamiento quirúrgico. Un paciente recidivó en dos ocasiones. El método de Ponseti es útil en el tratamiento del pie zambo sindrómico, aunque precisa un número mayor de yesos correctores que en el pie zambo idiopático. La deformidad residual más frecuente en esta muestra fue el adductus.
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Congenital talipes equinovarus
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Congenital talipes equinovarus (CTEV), also known as clubfoot, is a complex congenital deformity of the foot that, left untreated, can limit a person’s mobility by making it difficult and painful to walk. Worldwide, 80% of children born with clubfoot are in low- and middle-income countries. The management of clubfoot has a long history. Non-operative management did not become popular, as an increasing number of orthopaedists started leaning towards surgical treatment. The late Dr. Ignacio Ponseti developed a method of clubfoot correction that successfully realigns clubfoot in infants without extensive and major surgery. The aim of the study was to assess the functional outcome of CTEV management by the Ponseti technique, to study the severity of CTEV deformity using the Pirani score, and to evaluate the cost-effectiveness of the technique. A total of 356 cases with 402 feet with CTEV were treated by the Ponseti method. The average age of the children and the number of casts applied before full correction were 4.03 months and 6.91, respectively. There was a good functional outcome in 95.45% of cases (score > 30) at the last follow up. The management of CTEV by the Ponseti technique provides a good functional and cosmetic outcome. In a developing country like India, this technique is a safe, easy, economical method of clubfoot management.
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Background: Congenital talipes equinovarus (CTEV) is a prevalent congenital foot deformity. The Ponseti Method is a non-surgical treatment for clubfoot, which entails a sequence of casts and braces. The accelerated Ponseti method is a modified version of the standard Ponseti method, involving more frequent cast changes. Materials and Methods: A total of 60 patients with idiopathic CTEV under the age of one were carefully chosen and assigned to either group A (Standard) or group B (Accelerated). The Pirani score was used to evaluate each clubfoot before applying a cast. In group A, above-knee casting was performed once a week, while in group B, it was done twice a week Results: The study involved sixty children, accounting for a total of seventy feet. The results indicated a shorter treatment duration with the accelerated Ponseti method, while the occurrence of skin complications was comparable between the two methods. Conclusion: In conclusion, both the accelerated and standard Ponseti methods are equally effective in correcting clubfoot. The accelerated method offers the advantage of reducing the overall treatment duration and has clear benefits, while there is no notable difference in skin complications between the two methods.
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Congenital talipes equinovarus
Tenotomy
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